Rehabilitation of Spondylolysis

(what to expect)

Julie Sherry, PT, MS

UW Health Spine Clinic
jsherry2@uwhealth.org

PT

Interventions

Core Stabilization
Glute Strengthening
Joint Mobilization
Flexibility
Body Mechanics
Return to Sport Progression

Treatment: Core Stabilization

activation of deep abdominal muscles
transverse abdominus & internal oblique
draw-in

with co-activation of lumbar multifidi

swell back muscles

Why Abdominal Stabilization?

-Delay in transverse abdominal contraction
in patients with LBP*
-Lumbar multifidus atrophy correlated to the same
side and vertebral level of
symptomatic LBP**
*Hodges and Richardson. Inefficient muscular stabilization of the lumbar spine associated with low
back pain. A motor control evaluation of transversus abdominis. Spine 1(22): 2640-50. 1996.
** Hides etal. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in

patients with acute/subacute low back pain. Spine 19(2):165-72. 1994.

Phases of Core Stabilization

Phase 1: Core Initiation: supine, 4-point drawing-in
Phase 2: Static Stabilization: 4-point,

kneel,
standing drawing-in with arm/leg motion

Phase 3: Dynamic Stabilization: allow trunk

motion to occur with dynamic control

Phase 4: Reactive Core Control: dynamic

control during specific drills & various
environmental challenges

Core Initiation
Transverse Abdominus:
drawing-in
Lumbar Multifidus:
swell back muscles

NWB Static Stabilization

Standing Static Stabilization

Swiss Ball Dynamic Stabilization

rotation from above

rotation from below

Medicine
Ball
Dynamic
Stabilization

Treatment: Strengthening
Core Strengthening: External oblique
Gluteus Maximus: pelvic stability in sagittal
plane
Gluteus Medius: pelvic stability in fromtal
plane
Oblique Abdominals
Erector Spinae

Glute & External Oblique Strength

Squat with hip hinge

Backward lunge with twist

Glute Strength
Sidestep with band at knees ankles forefoot
in squat position (weight on heels)

in bow position (weight on heels)

Treatment: Joint Mobilization

if necessary: steal joint ROM from
elsewhere.
Mobilization of Hips
Manipulation of Thoracic spine

Hip

Thoracic Spine

Treatment: Flexibility
Hip Flexors: Psoas
and Quads
Latissimus Dorsi
(overhead athlete)
Hamstrings: tight from
growth spurt or
muscle spasming

Treatment: Flexibility

Treatment: Body Mechanics

Body Mechanics
Sleep: avoid sleeping prone (suggest body
pillow to break the habit)
School: unload backpack to10% BW (suggest
double copy of textbooks for home and
school, rolling bag); use both straps
Footwear: avoid flip flops, tie shoes, consider
arch supports to improve LE alignment

Treatment:
Return to Sport Progression
NWB to WB postures
Static to Dynamic Stabilization
Sport-Specific planes of movement,
speeds, loads, dosing impact

References
Hodges and Richardson. Inefficient muscular stabilization of the lumbar
spine associated with low back pain. A motor control evaluation of
transversus abdominis. Spine. 1996:1(22): 2640-50.
Hides etal. Evidence of lumbar multifidus muscle wasting ipsilateral to
symptoms in patients with acute/subacute low back pain. Spine.
1994:19(2):165-72.
O'Sullivan PB, Phyty GD, Twomey LT, Allison GT. Evaluation of
specific stabilizing exercise in the treatment of chronic low back pain
with radiologic diagnosis of spondylolysis or spondylolisthesis.
Spine. 1997: Dec 15;22(24):2959-67.
Klein G, Mehlman CT, and M McCarty. Nonoperative treatment of
spondylolysis and grade 1 spondylolisthesis in children and young
adults. A meta-analaysis. J Pediatr orthop. 2009: 29: 146-156.